Short-stay unit hospitalisation vs. Standard care outcomes in older internal medicine patients: a randomised clinical trial

Camilla Strøm; Lars Simon Rasmussen; Anne Sophie Löwe; Anne Kathrine Lorentzen; Nicolai Lohse; Kim Hvid Benn Madsen; Søren Wistisen Rasmussen; Thomas Andersen Schmidt

doi:10.1093/ageing/afy090

Short-stay unit hospitalisation vs. Standard care outcomes in older internal medicine patients: a randomised clinical trial

Camilla Strøm^*, Lars Simon Rasmussen, Anne Sophie Löwe, Anne Kathrine Lorentzen, Nicolai Lohse, Kim Hvid Benn Madsen, Søren Wistisen Rasmussen, Thomas Andersen Schmidt

^*Corresponding author af dette arbejde

Institut for Klinisk Medicin

5 Citationer (Scopus)

Abstract

Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic ‘fast-track’ principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. Results: between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37–1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17–0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36–147] vs. 100 h [IQR 47–169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22–0.61; P < 0.001). Conclusions: mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. Trial registration: NCT02395718.

Originalsprog	Engelsk
Tidsskrift	Age and Ageing
Vol/bind	47
Udgave nummer	6
Sider (fra-til)	810-817
ISSN	0002-0729
DOI	https://doi.org/10.1093/ageing/afy090
Status	Udgivet - 1 nov. 2018

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10.1093/ageing/afy090

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title = "Short-stay unit hospitalisation vs. Standard care outcomes in older internal medicine patients: a randomised clinical trial",

abstract = "Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic {\textquoteleft}fast-track{\textquoteright} principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. Results: between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37–1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17–0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36–147] vs. 100 h [IQR 47–169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22–0.61; P < 0.001). Conclusions: mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. Trial registration: NCT02395718.",

keywords = "Acutely admitted internal medicine patients, Age 75 years or older, Alternative hospitalisation strategies, Older people, Short-stay unit hospitalisation",

author = "Camilla Str{\o}m and Rasmussen, {Lars Simon} and L{\"o}we, {Anne Sophie} and Lorentzen, {Anne Kathrine} and Nicolai Lohse and {Benn Madsen}, {Kim Hvid} and Rasmussen, {S{\o}ren Wistisen} and Schmidt, {Thomas Andersen}",

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doi = "10.1093/ageing/afy090",

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TY - JOUR

T1 - Short-stay unit hospitalisation vs. Standard care outcomes in older internal medicine patients

T2 - a randomised clinical trial

AU - Strøm, Camilla

AU - Rasmussen, Lars Simon

AU - Löwe, Anne Sophie

AU - Lorentzen, Anne Kathrine

AU - Lohse, Nicolai

AU - Benn Madsen, Kim Hvid

AU - Rasmussen, Søren Wistisen

AU - Schmidt, Thomas Andersen

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic ‘fast-track’ principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. Results: between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37–1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17–0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36–147] vs. 100 h [IQR 47–169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22–0.61; P < 0.001). Conclusions: mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. Trial registration: NCT02395718.

AB - Background: the effect of hospitalisation in emergency department-based short-stay units (SSUs) has not been studied in older patients. We compared SSU hospitalisation with standard care at an Internal Medicine Department (IMD) in acutely admitted older internal medicine patients. Methods: pragmatic randomised clinical trial. We randomly assigned patients aged 75 years or older, acutely admitted for an internal medicine disease and assessed to be suitable for SSU hospitalisation to SSU hospitalisation or IMD hospitalisation. SSU hospitalisation was provided by a pragmatic ‘fast-track’ principle. The primary outcome was 90-day mortality. Secondary outcomes included adverse events, change in Lawton Instrumental Activities of Daily Living (IADL) score within 90 days from admission, in-hospital length of stay and unplanned readmissions within 30 days after discharge. Results: between January 2015 and October 2016, 430 participants were randomised (median age 84 years in both groups). Ninety-day mortality was 22(11%) in the SSU group and 32(15%) in the IMD group (odds ratio (OR) 0.66; 95% confidence interval (CI) 0.37–1.18; P = 0.16). When comparing the SSU group to the IMD group, 16(8%) vs. 45(21%) experienced at least one adverse event (OR 0.31; 95% CI 0.17–0.56; P < 0.001); 6(3%) vs. 35(20%) experienced a reduction in IADL score within 90 days from admission (P < 0.001); median in-hospital length of stay was 73 h [interquartile range, IQR 36–147] vs. 100 h [IQR 47–169], (P < 0.001), and 26(13%) vs. 58(29%) were readmitted (OR 0.37; 95% CI 0.22–0.61; P < 0.001). Conclusions: mortality at 90 days after admission was not significantly lower in the SSU group, but SSU hospitalisation was associated with a lower risk of adverse events, less functional decline, fewer readmissions and shorter hospital stay. Trial registration: NCT02395718.

KW - Acutely admitted internal medicine patients

KW - Age 75 years or older

KW - Alternative hospitalisation strategies

KW - Older people

KW - Short-stay unit hospitalisation

U2 - 10.1093/ageing/afy090

DO - 10.1093/ageing/afy090

M3 - Journal article

C2 - 29905758

AN - SCOPUS:85055666235

SN - 0002-0729

VL - 47

SP - 810

EP - 817

JO - Age and Ageing

JF - Age and Ageing

IS - 6

ER -

Short-stay unit hospitalisation vs. Standard care outcomes in older internal medicine patients: a randomised clinical trial

Abstract

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